Provider Demographics
NPI:1801899836
Name:ZICHELLA, SARAH L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:L
Last Name:ZICHELLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 K ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5120
Mailing Address - Country:US
Mailing Address - Phone:916-733-8277
Mailing Address - Fax:916-733-8226
Practice Address - Street 1:2801 K ST
Practice Address - Street 2:SUITE 410
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5120
Practice Address - Country:US
Practice Address - Phone:916-733-8277
Practice Address - Fax:916-733-8226
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15829363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA15829Medicaid
CAPA15829Medicaid
CAS51505Medicare UPIN